General Information

Generic Name: 
B comp no3/folic/C/biotin/zinc
Manufacturer: 
NEPHRO-TECH
NDC code: 
59528031701
Package Size: 
100
EA
Prescription/OTC: 
Over the counter
Family Planning drug: 
No
Diabetic Supply: 
No
HTW drug: 
No
HTWPlus drug: 
No
Long-acting reversible contraception product: 
No
Refill-to-soon Utilization*: 
75%
VDP Acquisition Cost: 
.2856
VAC eff date: 
06/03/2016
340B Cost: 
.16125
Premium Preferred Generic Incentive†: 
No

Pharmacist Administered

Injection: 
No

 

* Impacts only claims paid by the Vendor Drug Program: traditional Medicaid, CSHCN, HTW, and KHC Programs.

† To learn about traditional Medicaid claim pricing and PPG pricing incentives please refer to the Drug Pricing & Reimbursement (PDF) chapter of the VDP Pharmacy Provider Procedure Manual.

‡ Please review the lists of DUR board-approved clinical prior authorizations that apply to traditional Medicaid and those that health plans may use. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each health plan uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing. Refer to the MCO Resources for links to each health plan's active clinical prior authorizations.

KHC

KHC Effective date: 
12/21/2000

Compound-only Use by Program

Medicaid: 
No
CHIP: 
No
CSHCN: 
No
KHC: 
No